Biking harm reduction

I just got done talking to two reporters about e-cigarettes and THR. In one of those I had the nice rare opportunity to be able to reply to the comments of the apparently mandatory interviewee for these stories: a medic who seems to understand neither the products nor humanity, but insists on opining on them anyway. Re the lack of understanding of humanity, I pointed out to the reporter that — contrary to the views of that physician — people care about things other than just minimizing health risks (something I almost always have to do, in spite of the fact that most people I talk to are people, and so should already know this).

Of course, the entire “public health” iron triangle[*] (not to be confused with real public health) is premised on the notion that the only thing people care about is maximizing their longevity. Or perhaps their view is that people owe their lives to The State or to The Community (dare I say, to The Collective), and thus only productivity and costs-savings — not pesky little matters of happiness — matter. Either way, they never defend their position. They just take it as a premise and run with it, perhaps knowing that it is indefensible but trying to make people forget that they have no foundation by creating a huge edifice without one.

[*For those who do not know, “iron triangle” is the generalization of Eisenhower’s “military-industrial complex”, as applied to self-perpetuating, self-enriching special-interest industry/government/academia institutions other than the military.]

But having gone through that thought process, I came out the other side thinking about where “public health” people, along with those medics who think of patients as their serfs rather than their customers, recognize that maximizing longevity is the only thing that matters. I do not recall — in all my years of hanging out with people who engaged in these activities –ever hearing about a physician or “public health” type advising them to give up mountain climbing or commuting by bicycle. Each of these activities is far more dangerous than using low-risk tobacco products. The former (among those who do it seriously) is more dangerous than smoking. And yet not a peep from those who would ban large sodas or whose attitude toward THR is that (even if they acknowledge that is healthier than smoking) it is a poor substitute for the always-better choice of avoiding the behavior entirely.

Of course, I can hear the inevitable response to that, “but they are good exercise”. Trust me, you only hear that from people who have not done those activities. They are certainly exercise, and as such better than no exercise at all. But they are fairly lousy as exercise (which is clearly not the main motivation to do them), with a lot of fitness-inefficient starting and stopping, brutalization of tendons and other body parts that you might discover that you need later, and furious inhalation of bad air (either not enough of it or far too high a concentration particulate matter and toxic gasses from burned gasoline and diesel). That is to say nothing of the trauma risk. But can you even imagine a medic advising someone, “instead of commuting by bike, you would be better off driving to the gym, riding the stationary bike there for half an hour (during which you can get some reading done for the good of The Collective, something you cannot due while commuting), and then continuing on to work.” By “better off”, they of course mean healthier — what else matters after all?

If you actually had this discussion with a “public health” type special interest activist, you could count on them also responding that just commuting by bike, rather than switching to that reduced-harm version, is better for the environment. To which I say: Aha! So even if you do not care about people’s pleasures, health concerns do not trump all other human wants, do they!?

To head off some of my experience from my last post, of comments and nasty notes from people who know nothing of my work, I will point out that I am aware that “public health” types and activist physicians are generally authoritarian elitists who think of the plebs (and the environment) as helpless kittens who need to be protected. That is the charitable interpretation; the less charitable version being that they think of the plebs as savages who need to be civilized into proper moral behavior so they can be good members of The Collective. The people who they encounter who commute by bike and climb tend to be fellow elites, who can be trusted to make their own decisions, while the peasants who use tobacco need to be civilized. (What about the people who commute by bike — sans carbon fiber, lycra, and helmet — because they cannot afford to drive to their jobs, often on particularly unsafe roads? The “public health” types do not really care because that highly unhealthy activity is not “immoral”, and the physicians who are willing to see them understand that they probably have bigger health concerns.)

Still, we can ignore all that subtext and perhaps find a vein of good rhetorical fodder. When responding to an authoritarian who takes the “you would be better off not doing it” attitude, whether in an interview or personally, perhaps it would be useful to ask “so, do you recommend that people give up hobbies/sports that are just as hazardous in favor of just riding a stationary bike? Why not?”

10 responses to “Biking harm reduction”

Very interesting analysis Carl. And quite true. I’m constantly aware of, and unhappy with, the dangers of my bicycling for transportation out there in the roads with the Killer Detroit Mangling Machines (hhm… do you sense a bit of bias here?) and I’ve had several near-death experiences while thus riding.

But nope… never been advised to give it up! :>

There’s an antismoking study out there about secondhand smoke supposedly raising blood pressure in 10 year old boys by about 1mmHG. Made all sorts of headlines for a while, but if you read the study itself you found out that yes, it went up by this silly little amount in the boys, but it went DOWN a LARGER amount (maybe 1.5mmHG?) in little girls exposed to ETS.

Of course the researchers didn’t turn around and recommend that parents blow smoke at their little girls for some odd reason… the concern only went out for the boys. And in case anyone DID think of the smoke blowing, one of the researchers noted that the 1.5mmHG decrease in the girls might ALSO be a “cause for concern.”

Now, can you imagine ANY researcher ANYWHERE looking at the results of a study on the effects of kids eating an apple a day, finding it correlated with a reduction in blood pressure of 1.5mmHG and coming out with the statement that the reduction “might be a cause for concern”?

I ride a bike! Oh dear, I do sometimes wear lycra and a helmet on the road bike which is carbon fibre. On the mtb I tend not to wear a helmet, ride in jeans and it is alluminium. It’s a fashion thing lol. (You really do have to have the right glasses too). Slightly behind the times but worth a look http://thecycleofstyle.blogspot.co.uk/

What tees me off though is all those charadee rides, supported by the usual fake charities and PR merchants. I also dislike all the ‘healthy’, environmentally friendly stuff. I ride my bike because I just like riding my bike. (You can ride it if you like, it doesn’t have a basket but it does look good and I didn’t borrow it :)).

I do get people saying it’s good that I ride a bike (elite moi?) and, like Mr McFadden, no one has suggested I give it up (which is good because, did I mention, I like riding my bike).

I do wish Drs would go back to making repairs to people rather than nagging them and of course the Public ‘Health’ bods are not about health at all. Next time you’re having a chat with one, suggest they sign up for a spinning class, they will like that ;)

Did I say “elites”? (I had to go back and check — yes, I did.) Sloppy choice of words. I was trying to capture some notion of the ruling class versus the serf class (and there are other classes too). Not everyone in that ruling class is wealthy or all that powerful, but there is definitely a class there. While there is some middle ground, my experience (from both reading and on the road) is that there are two types of bike commuters: those whose lifestyle and social circles are such that biking to work is a point of pride, and who have enough liberties at work that either they can go to work just off a bike or they have a gym and a shower there (which tends to narrow it down to mostly the “elite” ruling class types) and people who cannot afford to drive and/or whose job is such that they can be sweaty and probably get more so at work (the plebs that the “public health” types think are too weak and stupid to make decisions for themselves).

Great post, I had never thought about e-cigs in this way and I think you definitely have the right idea. Cycling is the most serious cause of brain injuries and I would rather smoke than have a brain injury.

Okay, enough with the biking is dangerous thing. Biking is definitely not the leading cause of brain injuries. It doesn’t even make it on the list, but motor vehicle accidents are number one. What the statistics show is that biking is actually safer then riding in a motor vehicle with less accidents per vehicle hour. If you eliminate bike accidents by children it becomes even more so that biking is not all a very risky behavior. Just had to clear that up.

Oh…. I bike nearly every day without wearing Styrofoam and plastic on my head.

I know this has gotten a bit off topic but it goes that way sometimes.

Well, the post was half off-topic anyway, so I will indulge (and make it worse) it because I am curious. Call it a Thursday Science Lesson. Agreed that biking is probably not the leading cause of anything in the USA because it is not that popular. But about those statistics — I used to know them (when I focused on risk assessment and rode, which I sadly do not do anymore) but am curious if maybe you have recent ones. The “per vehicle hour” is potentially misleading when comparing to my commuting example. Biking is a lot slower, on average, and if the distance is fixed then “per vehicle hour” will underestimate the more relevant “per passenger mile”. The vehicle vs. passenger will do it some too — bikes always have just one while a car-hour might expose more than one person (though at commute time, usually not). Also, commuting is more dangerous than the average bike mile, which would include rides in parks and such.

So, do you know the latest numbers (and how they compare to car travel)? Last I recall, biking was in the order of 10x as dangerous as driving (per person-mile), and it seems unlikely that this has reversed. I would like to try to make sure my rhetorical statistics are right, though.

(Oh, and while a helmet definitely reduces risk, you are vindicated by the fact that it is really not a huge difference (unlike, say, seat belts in cars). I was pretty much never without one and it felt wrong without it. But despite the fanatical “must wear a helmet” mentality, it turns out to be one of those “public health” rules whose benefits are small enough that in a more ethical world, it would be balanced against personal preference.)

(And to get even further off-topic, I would guess that the leading cause of serious brain injury among Americans for the last decade is sending them off to fight losing land wars in Asia, but I don’t know the numbers.)

It does use Hours of Exposure rather then miles traveled but given the mode of transport it is not an unfair comparison. What the numbers show is that biking is not nearly as dangerous as we are lead to believe.

I live in Madison WI which is one of the more bike friendly cities in the country with a good amount of bike infrastructure. The city has a six percent bike share, but the Isthmus where I live likely has over twice that amount.
There is safety in numbers.

Interesting video. It nicely makes the point about the “public health” slippery slope that is hurting people in countless ways.

This tangent continues to offer good science lessons. One is about the importance of getting the right denominator and not mixing heterogeneous phenomena as if they were the same. Time is the right unit if you are contemplating going for a ride for an hour or going for a drive for an hour (does anyone still do that for recreation — I hope not!). But if you have a given distance to cover (e.g., you are commuting) then it clear is not. Even taking those numbers at face value, the last time I regularly commuted by bike, it took me less than 15 minutes to drive but I could only get the ride under 30 on my best days. And that is probably about as low as the ratio gets (surface streets with a fair amount of traffic and lights vs. mostly on a dedicated bike path along a bayou, albeit with stops at most road crossings). I would guess that the average speed of people in cars is 3 or 4 times the average speed of people on bikes.

But even that is not enough, due to the heterogeneity problem. Almost everyone in cars is exposed to the dangers of speed and traffic. Meanwhile a large fraction of bicycle hours are spent moving at near-pedestrian speeds and on minimally trafficked roads or car-free areas. Serious bike commuting, by contrast, tends to involve speeds of >20mph and proximity to cars, and so the average does not apply.

Consider that in relation to one of the claims in the video. The speaker mentioned statistics that showed a positive association between bike helmet use and injuries. While it has been observed that some motorists drive more dangerously near cyclists who are wearing helmets compared to being near those who are not, this is almost certainly mostly confounding not causation. It is simply impossible to believe that helmets actually increase the severity of injuries. Rather, helmet use is more common among (a) those who are riding more seriously (greater speed, on streets with traffic) and (b) children (not as good at it, more breakable). It still might be the case that your benefits of wearing a helmet are low enough that they do not exceed your costs (for a given person, on a given ride). This is especially clear if a helmet mandate causes someone to just forgo riding. But there is little doubt that for a given ride your physical risks are reduced by wearing it.

Having been a radical bicycle activist and dedicated urban bike transportation user (I’ve *never* driven a car!) for … hmm… over 40 years at this point, I’d have to echo Carl strongly. I’ve had several VERY close calls out there, and a lot that weren’t quite so close. If it weren’t for cars, bicycles would be very safe. If gasoline were currently taxed at the same per/unit rate as cigarettes then bicycles would be very safe. Back in my more “liberal” radical days I worked with my bicycle collective folks to do things like boost gasoline taxes and promote “car-free” zones and conditions and incentives as a way of “nudging” the ignorant drivers into a better lifestyle.

Today, probably largely thanks to having my eyes opened by the antismoking “nudgers,” I’m a lot more laissez-faire about it… but still wistfully thinking about how nice it would be if I could make about 90% of the cars (or “car-killers” as I used to always think and talk about them) disappear.

Tobacco Harm Reduction (THR)

THR is the public health strategy of encouraging smokers to switch to low-risk alternatives like smokeless tobacco and e-cigarettes. It is the only proven method for reducing smoking below about a fifth of the population once it becomes established. (So why would anyone be anti-THR? See the "About" page.)

The continuing scourge of [smoking]-produced disease is unlikely to yield to today’s "evidence-based" interventions. (scare quotes added) Kenneth E Warner; see post if the implications are not obvious

If someone says the sky is green, you prove that it’s actually blue, and the next day he comes back once again insisting that the sky is green, and this happens repeatedly, you eventually have to acknowledge that mannerly debate about the color of the sky just isn’t enough; you have to go meta, and talk about the fact that this guy and his friends just aren’t in the business of honest discussion. Paul Krugman

He who is merciful to the cruel will become cruel to the merciful. Ancient Midrash